Pathogenesis of quadriceps contracture in children and adolescence
Nemoto, F.
Nihon Seikeigeka Gakkai Zasshi 54(1): 15-31
1980
ISSN/ISBN: 0021-5325 PMID: 7381269 Document Number: 167664
Limbs (41) in 35 patients with quadriceps contracture were examined at operation and pathohistological examination was carried out for the whole length of the resected rectus femoris muscle to study pathogenesis of contracture of the quadriceps muscles. The age of patients at operation was 2 yr and 3 mo.-17 yr and 3 mo. Previous history of injection was positive in 29 cases, negative in 5 cases and unknown in 1 case. In cases with no previous history of injection the cross sections of the rectus femoris muscle macroscopically revealed that scar exists over the whole length of this muscle, showing clear boundary between scar and adjacent muscles. Pathohistological examination showed fibrosis of the muscle fibers and infiltration of fibrous tissues between muscle fibers. In cases with previous history of injection, pathohistological findings revealed that atrophy and degeneration were marked in the whole area of the muscle fibers compared to non-injection cases, although scar in muscle was not so clear macroscopically. As the operative findings in the cases with or without injection in the previous history, considerable adhesion and scar were seen in the muscles and fascias surrounding the rectus femoris muscle. To release contracture, it was necessary to detach these adhesions, to remove scar tissues and to cut the contracted fascia. Apparently, the chief cause for quadriceps muscle contracture can be attributable to the muscles showing contracture over the whole length and lacking normal elasticity, which produced adhesions caused in scar formation with surrounding muscles and fascias. The various clinical symptoms associated with quadriceps contracture depend upon the severity of such pathologic changes. The follow-up results obtained in these cases were satisfying. Findings at operation, pathohistological findings, operative technique and follow-up results justified recommending this method. It was impossible to clearly classify the cases into rectus type, vastus type or mixed type, according to the general criteria. All of the cases could be classified into mixed type. This may be explained by the small number of cases and only 41 limbs studied.